CH. 15 Health Disparities

What was the ACTS intervention to reduce Breast cancer treatment disparity?

1. 5 year survival is 13% lower in black than in white women 2. Disparity that cannot be explained by stage of disease at presentation 3. reasons for worse breast cancer outcomes in black women: non-adherence to breast cancer treatment Goal: increase adherence to chemotherapy

What are causes of rural health disparities?

1. Healthcare access --. higher uninsured rates, workforce shortage, availability of services, transportation options 2. Socioeconomic status--> lower income, unemployment - affects insurance 3. Unhealthy behaviors --> more likely to smoke, use alcohol, be overweight, physical inactive and have poor access to health foods (also related to community/environment)

Racial disparities: U.S vs Canada

1. Present in both countries, more extreme in U.S 2. Non-whites in the US, but not in canada, were more likely to have unmet health needs, to forgo needed medicines and the have lower perceived quality of care than were whites ( even though 19% of canada is non white and 62% of Us is non hispanic non white)

What are some barriers to health care?

1. United states--> cost is the principal barrier 2. Canada= waiting times (however long waiting times let to an unmet health need for only 3.5% of Canadians

What were strategies used by the ACTS intervention to reduce Breast cancer treatment disparity?

1. address attitudes, perceptions and stressors, that may impact adherence 2. encourage communication with health care providers regarding physical and emotional needs with attention to reach- discordant situations 3. provide tailored, understandable information about treatment and its rationale (race matched breast cancer survivor video messages from the black community)

What are actual disparities in health outcomes?

1. by race, income, immigrant status were NOT measured 2. only disparities in access to care, quality of care, satisfaction with care

What other approaches may be useful in addressing health disparities in social, community and groups?

1. community mobilization or advocacy may be useful to improve access to health care or remove improve access to health care or remove an environmental risk that is affecting a minority community (may be useful to increase community efficacy (capability and confidence to address a problem) 2. Ecological approaches can be used as a part of a coordinated community strategy to increase access to resources

What is the CDC's strategies to reduce disparities in obesity prevalence?

1. educational efforts to promote health eating and active living 2. increased emphasis on policy and environmental strategies ( How would these strategies differ for rural? Racial/ethnic minorities? Low income?)

What other factors are involved in health disparities other than race/ethnicity?

1. immigrant status 2. disability 3. sex or gender 4. sexual orientation 5. geography 6. income

What are income disparities?

1. income explains a lot, but not all, of racial disparities in health 2. Low income canadians have better access to medical care the do low income US residents 2. low income in both countries had disparities in perceived quality of care 3. disparities on the basis of immigrant status are more pronounced in the US. But, this comparison is problematic because the immigrant populations differ

What factors might contribute to the higher great cancer death rate observes in african american/ Black women?

1. lack of medical coverage 2. barriers to early detection and screening 3. unequal access to improvements in cancer treatment 4. What is this tied to? SES

What are perceived barriers to using health care services?

1. mistrust 2. concern they will not understand cultural practices 3. Physical difficulties (lack of transportation) 4. language

How to address health disparities

1. one of many barriers that hinder improvement in health disparities relates to coordination 2. so many organizations an agencies have roles to play and there is often overlap or different organizations working on the same problem without any communication or mutual awareness

Health disparities exist with respect to?

1. quality of health care 2. access to health care 3. levels and types of care 4. many health outcomes and clinical conditions

What are social, community and group approaches to address health disparities?

1. social network theory 2. community mobilization 3. social ecologic models 4. health communications theory (social marketing, mass media) - Social, cultural, community, organizations, policy contextual factors that contribute to racial/ethnic minority disparities - may vary by community and health problem - Social - address group norms, work with key influencers/community leaders

Who experiences health disparities?

1. there is a need to develop culturally relevant/ appropriate programs and interventions 2. this is often part of the issue of disparities in health among racial and ethnic minorities

What are racial/ethnic disparities in obesity and socioeconomic status?

1. tied to SES but not in all cases 2. an inverse association exists between family income and obesity among white females and some white males, but the association is not as strong or opposite for other racial/ethnic groups

What are individuals approaches to address health disparities?

1. to address individual knowledge and awareness (among a specific population) can use a. HBM b. TPB c. Social Cognitive theory d. Used to structure education interventions or programs

Why is SES a key factor in disparities?

Because of its significant implications for health - Low SES is associated with many health risks as well as lack of access to care

Other ways to address health disparities: Organizational Theory

Can be used to improve local, regional, state, or nation level organizations and systems that result in better access and care for disparities populations

What are the cultural competency standards?

Culture theory -the U.S department of Health and Human Services developed the national CLAS ( culturally and linguistically appropriate service) standards to help define cultural competency in practice

What are health disparities?

It refers to the differences in health status between the majority population and population subgroups

Health Disparities: Lack of Cultural competency

Lack of cultural competency in health care and services has been identified as another cause of health disparities for racial/ethnic minorities

Other ways to address health disparities: Multilevel approaches

THRIVE model - Built environment, social capital, services and institutions and structural factors

What do historical circumstances explain about health disparities?

They produce a trajectory of health - Vulnerability -Circumstance (exposure to disease, knowledge) - Response (attitudes, practice)

What causes health disparities?

a combination of vulnerability due to social economic status (SES) and inadequate systems together contribute significantly to differences in health status

What is an issue with individual approaches to health disparities?

only useful when applied to issues related to the specific population